Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sheila Melander

Clinical Mentor

Cheryl Martin

Committee Member

Dr. Debra Hampton

Committee Member

Dr. Steve Hester


Background: Advanced Practice Providers (APPs), specifically Nurse Practitioners (NP) and Physician Assistants (PA), have been utilized in healthcare for decades to improve access to care for patients. Norton Healthcare’s largest population of APPs is in specialty practices. The expansion of APPs into the medical group has been rapid and without evaluation of value and role identification.

Purpose: The purpose of this study is to evaluate Advanced Practice Provider (APP) practice patterns and care delivery models within specialty practices in a large medical group. The outcome of the study will help to identify trends in practice and areas where standardization might be achieved.

Methods: The study employed a cross-sectional, correlational design with the outcome to describe characteristics of the advanced practice population. Survey data was utilized to identify delivery of care models based on reported relationship between APP and physician.

Results: Three groups emerged from the survey data based on the practicing relationship between the APP and their physician partners. There was no statistical significance between the groups when comparing patient satisfaction, provider engagement, practice productivity, and practice readmission rates.

Conclusion: This study demonstrates the absence of APP standardization of practice in non-primary care practices. An opportunity to improve utilization of APPs at top of license and areas where standardization could be achieved was identified. In addition, this study reported a volume of work being performed by APPs without a value metric to track their productivity.